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Substance Use Disorders

In a study of veterans presenting with “mental health issues,” Danforth (2007) found that more than 60 percent may also have substance use disorders (SUD) (substance abuse or substance dependence).

People with co-occurring SUDs and PTSD tend to have been exposed to more severe trauma and may have more serious PTSD symptoms in several categories (e.g., avoidance, arousal, sleep problems) (Saladin et al., 1995).  The presence of PTSD also makes recovery from SUDs more difficult (VA, 2004;  Driessen et al., 2008).  For example, people with PTSD who are also dependent on alcohol or cocaine are far more likely to use those substances in unpleasant situations than are people who have PTSD alone, and people with cocaine dependence and PTSD are more likely to use even under pleasant situations (Waldrop et al., 2007).

The use or abuse of alcohol or other drugs may in many cases seem like a logical way to self-medicate the pain of post-deployment stress effects, if appropriate professional services are unavailable, or if professionally prescribed medications bring unacceptable side effects (Lighthall, 2008).  Alcohol is also easily accessible in Iraq (VA, 2004) and a time-honored element of the military tradition.

Even if Service Members refrained from drinking alcohol or using drugs in the war zone, they may return to previous drinking or drug-use patterns after their return to the United States, to cope with stress-related problems or manage traumatic stress reactions.  The presence of PTSD may also complicate their efforts to recover from substance-related problems (VA, 2004).

On a Public Broadcasting Service special called “The Soldier’s Heart,” one veteran described his substance use as a way of continuing the (parasympathetic) numbing process that had begun during deployment in Iraq.  “Two months after coming back, it all started hitting me.  Being numb over there, you come home, you can’t be numb anymore.  So you numb yourself with something.”

Substance use and abuse are in many ways misguided attempts to balance the brain’s chemistry (Scaer et al., 2008;  Gaty, 2008a).  Given the variety in the body’s chemical reactions to stress and trauma, it makes sense that different people would choose different substances.  For example:

  • Alcohol, tranquilizers, sedatives, and marijuana all serve to slow down a body and brain left sleepless and “in overdrive” by an overload of sympathetic stress chemicals.
  • Cocaine, methamphetamine, caffeine, and compulsive gambling are often attractive to people whose bodies have overreacted with the numbing, deadening, depressing parasympathetic chemicals, because they all increase levels of adrenaline and dopamine.
  • People whose bodies responded to the war zone with high levels of dopamine may feel particularly “let down” after they leave the field of battle, and gravitate toward chemicals and activities that increase dopamine levels.
  • People whose bodies responded to war-zone experiences with high levels of the natural opioids called endorphins may be drawn to heroin and prescription pain relievers when their natural chemicals subside after demobilization.
  • The severity of many Service Members’ and veterans’ injuries has also led to the prescription of opioid pain relievers, with the high risk and reality of dependence that often follows this use.

The tendency of stress and trauma to decrease the availability of serotonin in the brain further complicates these circumstances.  Not only do lower levels of serotonin contribute to depression (Neumeister, Young, and Stastny, 2004) and PTSD (Lee et al., 2005;  Zalsman et al., 2006;  Barr et al., 2004;  Gelernter, Pakstis, and Kidd, 1995), but they also might make it more difficult to control impulses, including the impulse to drink or use drugs.

One complicating factor is the presence of traumatic brain and spinal cord injuries in so many veterans.  Good and colleagues (2008) found that young men who have been socialized with strong masculine ideas and values—as many young male Service Members tend to be—have special challenges if they receive these or other serious injuries. They become more vulnerable to a number of risk-taking behaviors, including the misuse of alcohol, and less likely to seek or accept help (Good et al., 2008).

The presence of a traumatic brain injury can provide further complication.  Depending on the location and severity of the injury, it can increase impulsivity and/or decrease tolerance toward alcohol and other drugs (Rehabilitation Institute of Chicago, 1993).

Next: Depressive Disorders


The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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